'Everything in moderation' diet advice may lead to poor metabolic health in US adults

Diet diversity, as defined by less similarity among the foods people eat, may be linked to lower diet quality and worse metabolic health, according to researchers at The University of Texas Health Science Center at Houston (UTHealth) and the Friedman School of Nutrition Science and Policy at Tufts University. The study was published today in PLOS ONE.

"'Eat everything in moderation' has been a long-standing dietary recommendation, but without much empiric supporting evidence in populations. We wanted to characterize new metrics of diet diversity and evaluate their association with metabolic health," said Marcia C. de Oliveira Otto, Ph.D., first author and assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health.

Using data from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis, a study of whites, blacks, Hispanic-Americans and Chinese-Americans in the United States, the authors measured diet diversity through different measures. These included the total count (number of different foods eaten in a week), evenness (the distribution of calories across different foods consumed), and dissimilarity (the differences in food attributes relevant to metabolic health, such as fiber, sodium or trans-fat content).

Researchers evaluated how diet diversity was associated with change in waist circumference five years after the beginning of the study and with onset of Type 2 diabetes 10 years later. Waist circumference is an important indicator of central fat and metabolic health.

When evaluating both food count and evenness, no associations were seen with either increase in waist circumference or incidence of diabetes. In other words, more diversity in the diet was not linked to better outcomes. Participants who had the greatest food dissimilarity actually experienced more central weight gain, with a 120 percent greater increase in waist circumference than participants with the lowest food dissimilarity.

To compare with the results seen for diet diversity, the researchers also examined how diet quality relates to metabolic health. Diet quality was measured using established scores such as the Dietary Approaches to Stop Hypertension (DASH) score and the Alternative Healthy Eating Index (AHEI) score. At five years, diet quality was not associated with change in waist circumference.

At ten years, higher diet quality was associated with about a 25 percent lower risk of developing Type 2 diabetes.

"An unexpected finding was that participants with greater diversity in their diets, as measured by dissimilarity, actually had worse diet quality. They were eating less healthy foods, such as fruits and vegetables, and more unhealthy foods, such as processed meats, desserts and soda," said Otto. "This may help explain the relationship between greater food dissimilarity and increased waist circumference."

Dietary diversity as measured by food count and evenness was also associated with higher intakes of both healthy and unhealthy foods.

"Americans with the healthiest diets actually eat a relatively small range of healthy foods," said Dariush Mozaffarian, M.D., Dr.P.H., senior author and dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston. "These results suggest that in modern diets, eating 'everything in moderation' is actually worse than eating a smaller number of healthy foods."

Statin use may hinder effectiveness of flu vaccination

A new pair of studies suggests that statins, drugs widely used to reduce cholesterol, may have a detrimental effect on the immune response to influenza vaccine and the vaccine's effectiveness at preventing serious illness in older adults. Published in The Journal of Infectious Diseases, the findings, if confirmed by additional research, may have implications for flu vaccine recommendations, guidelines for statin use around the time of vaccination, and future vaccine clinical trials in seniors.

In one of the new studies, researchers analyzed immune response data from an earlier flu vaccine clinical trial conducted during the 2009-2010 and 2010-2011 flu seasons. In the new study, funded by Novartis Vaccines, which also sponsored the original clinical trial, investigators focused on the potential effect of statin use on patients' initial immune responses after being immunized against flu. The analysis drew on data for nearly 7,000 adults over the age 65 in four countries, including the United States.

Statin users had a significantly reduced immune response to vaccination compared to those not taking statins, as measured by the level of antibodies to the flu vaccine strains in patients' blood three weeks after being vaccinated, the researchers observed. The effect was most dramatic in patients on synthetic statins, rather than naturally derived statins.

"Apparently, statins interfere with the response to influenza vaccine and lower the immune response, and this would seem to also result in a lower effectiveness of influenza vaccines," said Dr. Steven Black, MD, of Cincinnati Children's Hospital Medical Center and lead author of the immune response study. If confirmed, the findings could support the preferential use of high-dose flu vaccine or vaccines containing adjuvants to boost immune response in the elderly, in an attempt to counteract the apparent effect, the study authors wrote.

A high-dose flu vaccine is approved for adults 65 and older in the U.S., as are several standard-dose vaccines. Adjuvanted flu vaccines are available in Europe and other countries but have not yet been licensed for use in the U.S. The Centers for Disease Control and Prevention recommends that everyone 6 months of age and older get a flu vaccine every season. Seniors are at particular risk for serious illness and complications from flu, including death.

In the other new study, conducted by researchers from Emory University, the authors investigated the possible impact of statin therapy on the effectiveness of flu vaccine at preventing serious respiratory illness. The researchers analyzed data spanning nine flu seasons from 2002 to 2011, including information about flu vaccination, statin prescriptions, and cases of medically attended, acute respiratory illness among nearly 140,000 people enrolled in a large managed care organization in Georgia.

"What we found was a potential signal that the effectiveness of flu vaccine in older people may be compromised somewhat if they are on statins, compared to those who are not on statins," said Saad B. Omer, MBBS, MPH, PhD, of Emory University and lead author of the vaccine effectiveness study, which was financially supported by Emory and the National Institute of Allergy and Infectious Diseases.

After adjusting for various factors, the Emory researchers observed that vaccine effectiveness for preventing serious respiratory illness was lower among patients taking statins compared to patients who were not on statins, particularly when flu was widespread in the state. The findings have potential implications for guidelines regarding statin use in older adults around the time of vaccination, but additional studies, including research examining laboratory-confirmed cases of flu, are needed first to provide more guidance, the study authors noted.

The results from both new studies are biologically plausible and raise important questions, but the findings should not yet affect how physicians care for their patients, according to a related editorial commentary by Robert L. Atmar, MD, and Wendy A. Keitel, MD, of Baylor College of Medicine in Houston.

"Instead, the results of these studies should be viewed as hypothesis-generating and should prompt further investigations into whether statins reduce inactivated influenza vaccine immunogenicity and, if so, the mechanisms by which immune responses and associated vaccine effectiveness are adversely affected," the commentary authors wrote. The commentary accompanies the two studies in The Journal of Infectious Diseases.

Fast Facts

Statins are used by more than 40 percent of the U.S. population over the age of 65, according to the Centers of Disease Control and Prevention.

In one study of flu vaccine recipients older than 65, statin users had a significantly reduced immune response to flu vaccination, compared to those not taking statins.

In another study, vaccine effectiveness at preventing serious respiratory illness was lower among patients taking statins compared to patients who were not on statins.

Additional research is needed to confirm the findings from both studies before potential changes in clinical practice are warranted.

Study: Count your bites; count down the pounds

Forget counting calories. The next new diet trend could be as simple as counting bites.

A new study from BYU health science researchers found people who counted bites over a month's time lost roughly four pounds--just about what the CDC recommends for "healthy" weight loss.

Those in the pilot test counted the number of bites they took each day and then committed to taking 20 to 30 percent fewer bites over the next four weeks. Participants who stuck with the task saw results despite changing nothing else about their eating and exercising routine.

"This study confirms what we already knew: consuming less food makes a difference," said lead study author Josh West. "We're not advocating people starve themselves, what we're talking about is people eating less than they're currently eating."

West and BYU coauthors Ben Crookston and Cougar Hall say that as a matter of priority, people who are overweight need to be more focused on the quantitative aspects of food and less on the qualitative aspects.

Their experiment asked 61 participants to count the number of times they lifted food to their mouth and the number of gulps of liquids, other than water, each day. At the end of each day, the subjects texted or emailed their totals to researchers.

The 41 test subjects who finished the experiment produced encouraging results, Crookston said, but there is more research needed to validate this strategy for long-term success.

"We felt pretty good about how much weight they lost given the relatively short span of the study," he said. "Now we need to follow up to see if they keep it off, or if they lose more weight."

Researchers said those who didn't finish the study had a hard time keeping up with counting bites. As a solution, researchers in BYU's Computer Science department have developed an algorithm that can do the counting for people.

That technology, created with the help of professor Christophe Giraud-Carrier, has now been licensed to local startup company SmartBites, whose team is refining it as an app for wearable devices such as Android Wear and WatchOS devices.

Crookston and West believe counting bites is a doable, cost-effective option for the 70 percent of Americans who are overweight.

"We're consuming considerably more calories than we did a generation ago or two generations ago; at the same time we're much less active," Crookston said. "The good news is that you don't have to be extreme calorie cutting. Even a 20 percent reduction in bites makes a difference."

The results from the pilot study appear in a recent issue of Advances in Obesity, Weight Management & Control.

Regular physical activity protects against depression after heart attack

In the study published in the prestigious American Journal of Medicine using data from the Nord-Trøndelag Health Study in Norway, the researchers studied whether pattern of leisure time physical activity among 189 patients prior to being hospitalized with first heart attack was associated with level of depressive symptoms after the initial heart attack.

The researchers found that those performing regular physical activity over 10 years prior to their first heart attack had almost 20% less odds of being depressed compared to their counterparts being stable inactive in the same period. The data also showed that those who changed from being inactive to become physical active prior to their first heart attack had a better protection against depression compared to those changed from being physical active to inactive. Dr. Linda Ernstsen, from the Sør-Trøndelag University College and K.G. Jebsen Center for Exercise in Medicine at the Norwegian University of Science and Technology (NTNU), and first author on the paper, says that "Our results add strength to the evidence of a causal link between physical activity and mental health".

"In fact we do not know if the heart attack itself is related to the prevalence of depression or if it is the change in physical activity level that is the driving force behind our findings. More research is definitely needed in this area" says Ernstsen.

This study has significant potential clinical impact as it reinforces the link between physical activity and depression and particularly emphasizes the need for patients at risk for heart disease and/or depression as well as those with these disorders to increase their levels of physical activity and regular exercise.

Achilles tendon disorders are common and often misdiagnosed

Mine was!

Achilles tendon disorders are common and often misdiagnosed, with about 25 percent of ruptures missed during initial examination, but the prognosis is favorable for the vast majority of patients, according to researchers from Rowan University School of Osteopathic Medicine and the Rothman Institute of Jefferson Medical College.

Their clinical review, published in the November edition of The Journal of the American Osteopathic Association, noted that most patients healed better with conservative treatment. Surgery should be reserved for acute tears occurring in young or very active patients.

"As an osteopathic physician, we approach treating injuries with the least amount of surgical intervention possible," said Joseph N. Daniel, DO, clinical associate professor of orthopaedic surgery at Jefferson Medical College in Philadelphia. "Injuries of the Achilles are no different, and this study validates that most patients are better off with conservative treatment."

Dr. Daniel noted that surgical intervention in younger, athletic patients is associated with lower rates of re-rupture and a quicker return to activity. Diagnostic imaging, such an ultrasound or MRI, is not recommended unless rupture is suspected.

The Achilles tendon is the largest tendon in the body and functions as the structural gateway between the leg, ankle, and foot. Its function is critical for walking, running, and jumping, so the injury is often associated with athletes, of whom eight percent will likely experience an acute rupture during their lifetime. About 24 percent of athletes will battle chronic tendinopathy at some point, researchers noted.

Achilles injuries are somewhat less common among non-athletes but frequently afflict the elderly and sedentary, as well as patients who've gained significant weight or started an exercise regimen in middle age. Ruptures are associated with autoimmune disease, plantar fasciitis, obesity, certain antibiotics, smoking, and localized steroid injections.

In acute cases, patients often report hearing a popping sound at the time of injury. Chronic ruptures and other Achilles injuries typically involve heel pain or discomfort that coincides with physical activity. Primary care physicians are urged to evaluate those with similar complaints for Achilles injuries and take a conservative approach to treatment.

"Mismanaged or neglected injuries will markedly decrease a patient's quality of life," said Dr. Daniel. "In all but a select few cases, we can resolve the issue with rest, over-the-counter medication, physical therapy, or a few weeks in a walking boot."

Exercise could give margin of safety to women who want to delay preventive mastectomy

Regular physical activity could play a role in helping women at high-risk of breast cancer delay the need for drastic preventive measures such as prophylactic mastectomy, according to new research led by the Perelman School of Medicine at the University of Pennsylvania. Results of the WISER Sister study help clarify the emerging connection between exercise and breast cancer risk. As a result of the new findings, the authors suggest that women who have an elevated breast cancer risk or worry about having such risk should consider doing 30 to 60 minutes of aerobic activity per day for five days per week. The results are available today in Breast Cancer Research and Treatment.

"Women who discover that they are at an increased risk of breast cancer, perhaps from an inherited gene mutation, have no easy option for avoiding cancer. Double mastectomy is considered an effective method of prevention, but that's an incredibly difficult decision to make," said Kathryn H. Schmitz, PhD, MPH, FACSM, a professor of Epidemiology and a member of the Abramson Cancer Center at Penn Medicine. "These new results show that for women in this high risk category, aerobic exercise has a striking ability to reduce the hormonally sensitive tissue in the breast that we worry about most for breast cancer."

Estrogen is likely a significant factor in the relationship between aerobic exercise and a reduced risk of breast cancer, as it normally stimulates an increase in breast cells. The vast majority of breast tumors appear to power their own spread in part by hijacking estrogen-signaling pathways. Moreover, studies have suggested that even moderate exercise can significantly lower estrogen levels, and intense exercise, such as that practiced by female athletes, commonly leads to sharp drops in estrogen levels, breast shrinkage, and irregular or even absent periods. "It makes sense that if your body is too busy doing other things, such as exercising regularly, it's going to know that it can't sustain other estrogen-dependent functions - including spreading cancerous cells - and thus will start to shut them down," Schmitz said.

In the study, the team recruited 139 premenopausal women aged 18-50 who were all deemed high-risk for breast cancer due to genetic mutations or family history. The "low-dose" group performed a treadmill exercise 150 minutes per week. The "high-dose" group exercised twice that amount. A control group exercised for less than 75 minutes per week. Each woman provided blood and urine samples, and also underwent MRI breast imaging, before and after each of five menstrual cycles.

Over the course of the study, the control group showed a 20 percent increase in estrogen-sensitive breast tissue, as measured by MRI, whereas the low- and high-dose groups saw reductions of about eight and 12 percent respectively--implying a drop of about 10 percent per 100 minutes of exercise.

Until now, almost nothing has been known about the effect of exercise on breast cancer risk in women who have strong family histories of breast cancer or genetic mutations that increase the risk of a breast cancer diagnosis. Women with BRCA1 mutations face lifetime breast cancer risks that can be well over 50 percent, if they don't take preventive measures. Doctors and insurers commonly advise BRCA mutation carriers to cut their risk with mastectomy as well as the removal of their ovaries. Some women alternatively take drugs that radically reduce estrogen signaling, and have menopause-like side effects, often sending young women into early menopause.

"This research shows one more potential benefit of exercise for women at high risk for breast cancer," said Sue Friedman, executive director of the nonprofit organization Facing Our Risk of Cancer Empowered (FORCE), which helped recruit women for the study. "We hope this will lead to further research on ways in which high risk women can reduce their breast cancer risk."

Schmitz and her colleagues are currently seeking funding for a similar study in premenopausal women who are not considered at high risk for breast cancer.

"We understand that exercise isn't a panacea that will prevent cancer from occurring in women at high risk," Schmitz said. "However, we do believe that exercise could delay the diagnosis, and reduce the stage and grade and severity of the tumor when it is diagnosed. I often meet woman who say 'I just found out I am BRCA positive--will exercise help me until I make my decision about my surgery?' And for years I had to say 'I don't know,'" said Schmitz, adding, "Now I can say the research suggests it's possible."

Eating more fruits, veggies in youth linked to healthy heart decades later

Eating more fruits and vegetables as a young adult may keep your arteries free of heart disease 20 years later, according to research in the American Heart Association journal Circulation.

Researchers found that eating more fruits and vegetables as young adults was associated with less calcified coronary artery plaque 20 years later. Coronary artery calcium can be measured by a CT scan to detect the presence and amount of atherosclerosis, a disease that hardens arteries and underlies many types of heart disease.

The researchers divided data from 2,506 study participants into three groups, based on their daily consumption of fruits and vegetables. Women in the top third ate an average of nearly nine servings of daily fruits and vegetables and men averaged more than seven daily servings. In the bottom third, women consumed an average 3.3 daily servings and men 2.6 daily servings. All servings were based on a 2,000-calorie-a-day diet.

Researchers found that people who ate the most fruit and vegetable at the study's start had 26 percent lower odds of developing calcified plaque 20 years later, compared to those who ate the least amount of fruits and vegetables.

Previous studies have shown a strong association between eating more fruits and vegetables and reduction in heart disease risk among middle-age adults. However, this is the first study to examine whether eating more fruits and vegetables as young adults could produce a measurable improvement in the health of their heart and blood vessels years later.

"People shouldn't assume that they can wait until they're older to eat healthy--our study suggests that what you eat as a young adult may be as important as what you eat as an older adult, " said lead author Michael D. Miedema, M.D., senior consulting cardiologist and clinical investigator at the Minneapolis Heart Institute, Minneapolis, Minnesota.

Researchers studied health information from adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a government-funded study of black and white young adults, which started in 1985. At the study's start, participants provided a detailed diet history, information on other lifestyle variables and cardiovascular risk factors such as blood pressure, whether or not they smoked cigarettes, weight and others. Twenty years later, participants underwent a CT scan to check for buildup of calcium on the walls of the arteries of the heart, which is calculated as a coronary artery calcium score. Higher coronary calcium scores are associated with a higher risk for heart attacks and other coronary heart disease events.

"Our findings support public health initiatives aimed at increasing fruit and vegetable intake as part of a healthy dietary pattern," Miedema said. "Further research is needed to determine what other foods impact cardiovascular health in young adults."

Low-weight, high-repetition exercise increases bone density up to 8 percent in adults

A new research study published in The Journal of Sports Medicine and Physical Fitness finds that low-weight, high-repetition resistance training increases bone mineral density in adults, challenging assumptions that heavy weight-training is required to build bone mineral density. Participants who completed the study experienced up to 8 percent bone mineral density increases in the legs, pelvis, arms and spine.

The full study titled, "Low Load, High Repetition Resistance Training Program Increases Bone Mineral Density In Untrained Adults," is now available at http://www.minervamedica.it/en/journals/sports-med-physical-fitness/article.php?cod=R40Y9999N00A150155&acquista=1.

The findings indicate that this type of strength training may be an effective and maintainable method of increasing bone mineral density in older people and sedentary groups. A secondary finding indicates postmenopausal women and osteopenic individuals (those with low bone mineral density) would benefit most from a low-weight, high-repetition exercise regimen.

"These findings challenge the traditional thought that high-weight, low-repetition exercise is the ideal way to increase bone mineral density," said Jinger Gottschall, Associate Professor and lead researcher of the study conducted at Penn State. "This is such a profound finding because low-weight, high-repetition exercise is easily attainable by anybody and everybody. This approach could help at-risk populations minimize the risk of osteoporosis."

In the study, 20 untrained adults (people who completed less than 30 minutes of exercise per week for the previous six months) completed a 27-week group exercise program. Participants were assigned to one of two groups that either completed full-body weight-training workouts or workouts focused on building core muscles, in addition to cardiovascular workouts. The weight-training group completed two to three BODYPUMP(R); classes per week, a low-weight, high-repetition resistance training program in which the participants used a bar and self-selected weights.

The study analysis found:

• Participants in the weight-training group demonstrated an 8 percent increase in leg bone mineral density, a 7 percent increase in pelvis bone mineral density, a 4 percent increase in arm bone mineral density and a 4 percent increase in spine bone mineral density. The core group's bone mineral density did not change significantly.
• Postmenopausal women and osteopenic individuals experienced significant bone mineral density increases of up to 29 percent.
• A positive correlation between squat strength and pelvis bone mineral density, a link that indicates the exercises used in the study could effectively decrease the risk of a hip fracture.
• Significant bone mineral density increases for osteopenic and postmenopausal people

Two osteopenic individuals and three postmenopausal women participated in the study, and both groups experienced much higher increases in bone mineral density than the rest of the group. Individuals with osteopenia experienced leg and pelvis bone mineral density increases of 29 percent, more than triple the results other participants experienced. The postmenopausal participants' bone mineral density increases ranged from 10 to 22 percent.

Pelvis and leg strength prevent fractures

In the study, people in the weight-training group experienced 25 percent greater increase in leg strength than those in the core group. Changes in leg strength were also strongly correlated with changes in pelvic bone mineral density.

According to the National Osteoporosis Foundation, by 2020 approximately 14 million people over the age of 50 are expected to have osteoporosis and another 47 million to have low bone mass.(1) After age 40, bone mineral density declines at an accelerated rate;(2) therefore, it is crucial to build a peak bone mass before this rapid decline and to maintain bone mass later in life.

The hip is the most common and devastating fracture site for elderly people with osteoporosis.(3) According to Gottschall, a large proportion of fall-related deaths are due to complications following a hip fracture. One out of five hip fracture patients die within a year of their injury. Maintaining a healthy bone mineral density in the pelvis and legs can help prevent these life-altering breaks, says Gottschall. High-repetition exercise is a great way for people to build full-body strength.

"Heavy weightlifting has been shown to increase bone mineral density, however many older and inactive adults cannot safely participate in this type of strenuous activity. The exercise regimen used in this study is a more feasible option," said Bryce Hastings, Group Fitness Research Officer, Les Mills International. "The beauty of LES MILLS BODYPUMP is that it is built on high-repetition choreography and instructors can identify progressive movement options for participants of any fitness level so they can build strength and bone density."

Acid reflux medications may increase kidney disease risk

Certain medications commonly used to treat heartburn and acid reflux may have damaging effects on the kidneys, according to two studies that will be presented at ASN Kidney Week 2015 November 3¬-8 at the San Diego Convention Center in San Diego, CA. The drugs, proton pump inhibitors (PPIs), are among the top 10 class of prescribed medications in the United States. Popular PPIs include Prilosec, Prevacid, Aciphex, and Nexium.

The prevalence of chronic kidney disease (CKD) is on the rise, with more than 20 million Americans burdened by the disease. Diabetes and hypertension are common risk factors for CKD; however, certain medications can also play a role. Two new studies show that increased use of proton pump inhibitors (PPIs), medications that treat reflux and stomach ulcers, may be contributing to the CKD epidemic.

In one study, Benjamin Lazarus, MBBS (Johns Hopkins University) and his colleagues followed 10,482 adults with normal kidney function from 1996 to 2011. They found that PPI users were between 20% and 50% more likely to develop CKD than non-PPI users, even after accounting for baseline differences between users and non-users. This discovery was replicated in a second study, in which over 240,000 patients were followed from 1997 to 2014. "In both studies, people who used a different class of medications to suppress stomach acid, known as H2-blockers, did not have a higher risk of developing kidney disease," said Dr. Lazarus. "If we know the potential adverse effects of PPI medications we can design better interventions to reduce overuse."

In another study, Pradeep Arora, MD (SUNY, Buffalo) and his team found that among 24,149 patients who developed CKD between 2001 and 2008 (out of a total of 71,516 patients), 25.7% were treated with PPIs. Among the total group of patients, those who took PPIs were less likely to have vascular disease, cancer, diabetes, hypertension, and chronic obstructive pulmonary disease, but PPI use was linked with a 10% increased risk of CKD and a 76% increased risk of dying prematurely.

"As a large number of patients are being treated with PPIs, health care providers need to be better educated about the potential side effects of these drugs, such as CKD," said Dr. Arora. "PPIs are often prescribed outside of their approved uses, and it has been estimated that up to two-thirds of all people on PPIs do not have a verified indication for the drug."

Parabens, used in shampoos, cosmetics, body lotions, and sunscreens, increase risk of breast cancer

Estrogen-mimicking chemicals called parabens, which are commonly found in an array of personal care products, may be more dangerous at lower doses than previously thought, according to a new study. The findings, published online October 27 in Environmental Health Perspectives, could have implications for the development of breast cancer and other diseases that are influenced by estrogens. The study also raises questions about current safety testing methods that may not predict the true potency of parabens and their effects on human health.

Parabens are a class of preservatives widely-used in consumer products like shampoos, cosmetics, body lotions, and sunscreens. The chemicals are considered estrogenic because they activate the same estrogen receptor as the natural hormone estradiol. Studies have linked exposure to estradiol and related estrogens with an increased risk of breast cancer, as well as reproductive problems. As a result, the use of parabens in consumer products increasingly has become a public health concern.

How much parabens might contribute to breast cancer risk is unclear. "Although parabens are known to mimic the growth effects of estrogens on breast cancer cells, some consider their effect too weak to cause harm," says lead investigator Dale Leitman, a gynecologist and molecular biologist at University California, Berkeley. "But this might not be true when parabens are combined with other agents that regulate cell growth."

However, existing chemical safety tests, which measure the effects of chemicals on human cells, look only at parabens in isolation and fail to take into account that parabens could interact with other types of signaling molecules in the cells to increase breast cancer risk. "Scientists and regulators are using potency estimates from these kinds of tests and are assuming they are relevant to what goes on in real life. But if you don't design the right test, you can be off by a lot," says co-author Ruthann Rudel, a toxicologist at Silent Spring Institute.

To better reflect what goes on in real life, the researchers looked at breast cancer cells expressing two types of receptors: estrogen receptors and HER2. Approximately 25 percent of breast cancers produce an abundance of HER2, or human epidermal growth factor receptor 2. HER2-positive tumors tend to grow and spread more aggressively than other types of breast cancer.

The researchers activated the HER2 receptors in breast cancer cells with a growth factor called heregulin that is naturally made in breast cells, while exposing the cells to parabens. Not only did the parabens trigger the estrogen receptors by turning on genes that caused the cells to proliferate, the effect was significant: The parabens in the HER2-activated cells were able to stimulate breast cancer cell growth at concentrations 100 times lower than in cells that were deprived of heregulin.

The study demonstrates that parabens may be more potent at lower doses than previous studies have suggested, which may spur scientists and regulators to rethink the potential impacts of parabens on the development of breast cancer, particularly on HER2 and estrogen receptor positive breast cells.

"While this study focused on parabens, it's also possible that the potency of other estrogen mimics have been underestimated by current testing approaches," says co-author Chris Vulpe, a toxicologist who is now at the Center for Environmental and Human Toxicology at the University of Florida College of Veterinary Medicine.

Since people come into contact with multiple chemicals every day through consumer products, understanding how mixtures of hormone-mimicking chemicals and growth factors interact to promote cell growth might better reflect a person's potential cancer risk from exposure. In particular, one area of increasing concern is how exposure to multiple chemicals during critical periods of development including puberty and pregnancy increases a person's susceptibility to breast cancer later in life.

Obese children's health rapidly improves with sugar reduction unrelated to calories

Reducing consumption of added sugar, even without reducing calories or losing weight, has the power to reverse a cluster of chronic metabolic diseases, including high cholesterol and blood pressure, in children in as little as 10 days, according to a study by researchers at UC San Francisco and Touro University California.

"This study definitively shows that sugar is metabolically harmful not because of its calories or its effects on weight; rather sugar is metabolically harmful because it's sugar," said lead author Robert Lustig, MD, MSL, pediatric endocrinologist at UCSF Benioff Children's Hospital San Francisco. "This internally controlled intervention study is a solid indication that sugar contributes to metabolic syndrome, and is the strongest evidence to date that the negative effects of sugar are not because of calories or obesity."

Jean-Marc Schwarz, PhD of the College of Osteopathic Medicine at Touro University California and senior author of the paper added, "I have never seen results as striking or significant in our human studies; after only nine days of fructose restriction, the results are dramatic and consistent from subject to subject. These findings support the idea that it is essential for parents to evaluate sugar intake and to be mindful of the health effects of what their children are consuming."

The paper will appear online on October 27, and in the February 2016 issue of the journal Obesity.

Restricting Sugar Intake

Metabolic syndrome is a cluster of conditions -- increased blood pressure, high blood glucose level, excess body fat around the waist, and abnormal cholesterol levels -- that occur together and increase risk of heart disease, stroke, and diabetes. Other diseases associated with metabolic syndrome, such as non-alcoholic fatty liver disease and type 2 diabetes, now occur in children -- disorders previously unknown in the pediatric population.

Participants were identified through the Weight Assessment for Teen and Child Health Clinic (WATCH) at UCSF Benioff Children's Hospital San Francisco, an interdisciplinary obesity clinic dedicated to targeting metabolic dysfunction rather than weight loss. Recruitment was limited to Latino and African-American youth because of their higher risk for certain conditions associated with metabolic syndrome, such as high blood pressure and type 2 diabetes.

In the study, 43 children between the ages of 9 and 18 who were obese and had at least one other chronic metabolic disorder, such as hypertension, high triglyceride levels or a marker of fatty liver, were given nine days of food, including all snacks and beverages, that restricted sugar but substituted starch to maintain the same fat, protein, carbohydrate, and calorie levels as their previously reported home diets. Baseline fasting blood levels, blood pressure, and glucose tolerance were assessed before the new menu plan was adopted. The study menu restricted added sugar (while allowing fruit), but substituted it by adding other carbohydrates such as bagels, cereal and pasta so that the children still consumed the same number of calories from carbohydrate as before, but total dietary sugar was reduced from 28 to 10 percent, and fructose from 12 to 4 percent of total calories, respectively. The food choices were designed to be "kid food" - turkey hot dogs, potato chips, and pizza all purchased at local supermarkets, instead of high sugar cereals, pastries, and sweetened yogurt.

Children were given a scale and told to weigh themselves everyday, with the goal of weight stability, not weight loss. When weight loss did occur (a decrease of an average of 1 percent over the 10-day period but without change in body fat), they were given more of the low-sugar foods.

"When we took the sugar out, the kids started responding to their satiety cues," said Schwarz. "They told us it felt like so much more food, even though they were consuming the same number of calories as before, just with significantly less sugar. Some said we were overwhelming them with food."

Reducing Harmful Metabolic Effects of Obesity

After just 9 days on the sugar-restricted diet, virtually every aspect of the participants' metabolic health improved, without change in weight. Diastolic blood pressure decreased by 5mm, triglycerides by 33 points, LDL-cholesterol (known as the "bad" cholesterol) by 10 points, and liver function tests improved. Fasting blood glucose went down by 5 points, and insulin levels were cut by one-third.

"All of the surrogate measures of metabolic health got better, just by substituting starch for sugar in their processed food -- all without changing calories or weight or exercise," said Lustig. "This study demonstrates that 'a calorie is not a calorie.' Where those calories come from determines where in the body they go. Sugar calories are the worst, because they turn to fat in the liver, driving insulin resistance, and driving risk for diabetes, heart, and liver disease. This has enormous implications for the food industry, chronic disease, and health care costs."

Excess body weight = increased risk of colorectal cancer

Experts speaking at the 23rd United European Gastroenterology Week (UEG Week 2015) in Barcelona, Spain today revealed compelling evidence of the link between e(CRC) Experts speaking at the 23rd United European Gastroenterology Week (UEG Week 2015) in Barcelona, Spain today revealed compelling evidence of the link between excess body weight and risk of colorectal cancer (CRC). John Mathers, Professor of Human Nutrition from the Institute of Cellular Medicine at Newcastle University in the UK presented data showing an overall increase of 18% in relative risk of CRC per 5 unit increase in BMI.

"In addition, in men, there is now evidence that increasing waist circumference in middle age is associated with increased bowel cancer risk", says Prof. Mathers. CRC risk was increased by nearly 60% in men who gained at least 10 cm in waist circumference over 10 years. "This increased cancer risk may be due to persistent inflammation in people with obesity".

Patients with Lynch Syndrome (LS) have a higher than normal risk of CRC because of an inherited defect in one of the genes responsible for repairing DNA. Prof. Mathers presented new data showing that, in people with Lynch Syndrome, CRC risk increases with higher body weight and for those who are obese the risk of CRC is doubled. Quite surprisingly, the increase in CRC risk with higher body weight in people with Lynch Syndrome was about twice as great as that seen in the general population.

Prof. Mathers said "There is now compelling evidence that improved lifestyle, particularly better dietary choices and being more physically active, can help to prevent obesity and this will lower bowel cancer risk". In addition, for those people who are already too heavy, losing weight may reduce their CRC risk but this is an area which requires further study. In his studies with Lynch Syndrome patients, Prof. Mathers observed that aspirin lowered the excess CRC risk seen in patients with obesity, perhaps through its anti-inflammatory effects. "This is a very intriguing finding" said Prof Mathers "which suggests that dietary and other anti-inflammatory agents might be beneficial in reducing CRC risk in people with obesity".

"Bowel cancer is strongly associated with age, obesity and diet - and is driven by inflammation", explains Prof. Mathers. "We can now give the public clear advice on the benefits of staying physically active, eating a healthy diet and avoiding weight gain to lower CRC risk as we get older".

Prolonged TV viewing linked to 8 leading causes of death in US

On average, 80% of American adults watch 3.5 hours of television per day and multiple observational studies have demonstrated a link between TV viewing and poorer health. In this new study published in the December issue of the American Journal of Preventive Medicine, investigators reported an association between increasing hours of television viewing per day and increasing risk of death from most of the major causes of death in the United States.

Virtually all Americans (92%) have a television at home and watching TV consumes more than half of their available leisure time, potentially displacing more physical activities. Previous studies had reported a relationship between TV viewing and elevated risk of death from cancer and cardiovascular disease. In this study, researchers at the National Cancer Institute looked at more than 221,000 individuals aged 50-71 years old who were free of chronic disease at study entry. They confirmed the association for higher mortality risk from cancer and heart disease. In addition, they identified new associations with higher risk of death from most of the leading causes of death in the U.S., such as, diabetes, influenza/pneumonia, Parkinson's disease, and liver disease.

"We know that television viewing is the most prevalent leisure-time sedentary behavior and our working hypothesis is that it is an indicator of overall physical inactivity. In this context, our results fit within a growing body of research indicating that too much sitting can have many different adverse health effects," explained lead investigator Sarah K. Keadle, PhD, MPH, Cancer Prevention Fellow, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute.

Dr. Keadle cautioned that although each of the associations observed have plausible biological mechanisms, several associations are being reported for the first time and additional research is needed to replicate these findings and to understand the associations more completely. "Our study has generated new clues about the role of sedentary behavior and health and we hope that it will spur additional research."

The study found that compared to those who watched less than one hour per day, individuals who reported watching 3-4 hours of television watching per day were 15% more likely to die from any cause; those who watched 7 or more hours were 47% more likely to die over the study period. Risk began to increase at 3-4 hours per day for most causes they examined. The investigators took a number of other factors into consideration that might explain the associations observed, such as caloric and alcohol intake, smoking, and the health status of the population, but when they controlled for these factors in statistical models, the associations remained.

Another important finding of the study is that the detrimental effects of TV viewing extended to both active and inactive individuals, "Although we found that exercise did not fully eliminate risks associated with prolonged television viewing, certainly for those who want to reduce their sedentary television viewing, exercise should be the first choice to replace that previously inactive time," said Dr. Keadle.

Investigators caution that more research is needed to explore connection between TV viewing and mortality and whether these same associations are found when we consider sitting in other contexts, such as driving, working, or doing other sedentary leisure-time activities. "Older adults watch the most TV of any demographic group in the U.S.," concluded Dr. Keadle. "Given the increasing age of the population, the high prevalence of TV viewing in leisure time, and the broad range of mortality outcomes for which risk appears to be increased, prolonged TV viewing may be a more important target for public health intervention than previously recognized."

Breastfeeding = reduced risk of aggressive breast cancer

A large international study shows that breastfeeding is associated with a lower risk of developing an aggressive form of breast cancer called hormone-receptor negative. This new combined evidence shows the risk was reduced by up to 20% in women who breastfed. Published in Annals of Oncology, this breastfeeding meta-analysis is a collaboration between Breastcancer.org; Icahn School of Medicine at Mount Sinai; Washington University, St. Louis; and the American Cancer Society.

Hormone-receptor-negative (HRN) breast cancers are more likely to be aggressive and life-threatening. This subtype is more commonly diagnosed in women under age 50. Women of African American or Sub-Saharan African descent are more likely to be diagnosed with HRN breast cancers, as are women with the BRCA1 gene mutation. Other factors may put these women at even higher risk for developing HRN breast cancer, including obesity and multiple early pregnancies. Furthermore, women with these multiple risk factors are least likely to breastfeed.

In the United States, HRN breast cancers represent about 20% of all breast cancers. This subtype of breast cancer has no receptors for the hormones estrogen or progesterone; about two-thirds of these HRN cancers also have no receptors for HER2 (human epidermal growth factor receptor 2). Breast cancers with no receptors for estrogen, progesterone, or HER2 are called triple negative (TN).

HRN and TN breast cancer are more often deadly because they tend to be diagnosed at later stages, respond to fewer treatment options, and are less likely to be cured by current therapies. In the absence of the receptors for estrogen, progesterone, and HER2, medicines that target these receptors--such as tamoxifen, aromatase inhibitors, Herceptin, and Perjeta--are ineffective and thus have no role in treating these patients.

"Further evidence to support the long-term protection of breastfeeding against the most aggressive subtypes of breast cancer is very encouraging and actionable," says Marisa Weiss, M.D., president and founder, Breastcancer.org, and director of breast health outreach, Lankenau Medical Center. "Breastfeeding is a relatively accessible, low-cost, short-term strategy that yields long-lasting natural protection."

This work highlights the need for more public health strategies that directly inform women and girls about the maternal (and fetal) benefits of breastfeeding before and during a woman's child-bearing years. It's also important for these women to have the message reinforced by their healthcare professionals.

It's critical to remove the barriers to breastfeeding at home, in the community and in the workplace. "All approaches will be necessary in order to protect the most women against the devastation of breast cancer over their lifetimes," says Farhad Islami, M.D., Ph.D., director of interventions, Surveillance and Health Services Research, American Cancer Society.

"Pregnant women and young mothers are highly receptive and motivated to make healthy choices. We need to encourage women who are able to breastfeed to do so for their breast health, in addition to the health of their children," says Paolo Boffetta, M.D., associate director for population sciences at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai. "Further prospective research will be necessary to further understand the full impact of breastfeeding duration and its effect on other subtypes."

Consumption of red meat and processed meat causes cancer

The International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, has evaluated the carcinogenicity of the consumption of red meat and processed meat. 

Red meat 

After thoroughly reviewing the accumulated scientific literature, a Working Group of 22 experts from 10 countries convened by the IARC Monographs Programme classified the consumption of red meat as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect.
This association was observed mainly for colorectal cancer, but associations were also seen for pancreatic cancer and prostate cancer. 

Processed meat
Processed meat was classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer. 

Meat consumption and its effects
The consumption of meat varies greatly between countries, with from a few percent up to 100% of people eating red meat, depending on the country, and somewhat lower proportions eating processed meat.
The experts concluded that each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%.

“For an individual, the risk of developing colorectal cancer because of their consumption of processed meat remains small, but this risk increases with the amount of meat consumed,” says Dr Kurt Straif, Head of the IARC Monographs Programme. “In view of the large number of people who consume processed meat, the global impact on cancer incidence is of public health importance.” 

The IARC Working Group considered more than 800 studies that investigated associations of more than a dozen types of cancer with the consumption of red meat or processed meat in many countries and populations with diverse diets. The most influential evidence came from large prospective cohort studies conducted over the past 20 years. 

Public health 

”These findings further support current public health recommendations to limit intake of meat,” says Dr Christopher Wild, Director of IARC. “At the same time, red meat has nutritional value. Therefore, these results are important in enabling governments and international regulatory agencies to conduct risk assessments, in order to balance the risks and benefits of eating red meat and processed meat and to provide the best possible dietary recommendations.”

Red meat refers to all types of mammalian muscle meat, such as beef, veal, pork, lamb, mutton, horse, and goat. 

Processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation. Most processed meats contain pork or beef, but processed meats may also contain other red meats, poultry, offal, or meat by-products such as blood. 

Examples of processed meat include hot dogs (frankfurters), ham, sausages, corned beef, and biltong or beef jerky as well as canned meat and meat-based preparations and sauces. 

 Q&A on the carcinogenicity of the consumption of red meat and processed meat 

Q. Do methods of cooking meat change the risk?
A. High-temperature cooking methods generate compounds that may contribute to carcinogenic
risk, but their role is not yet fully understood.

Q. What are the safest methods of cooking meat (e.g. sautéing, boiling, broiling, or barbecuing)?
A. Cooking at high temperatures or with the food in direct contact with a flame or a hot surface, as in barbecuing or pan-frying, produces more of certain types of carcinogenic chemicals (such as polycyclic aromatic hydrocarbons and heterocyclic aromatic amines). However, there were not enough data for the IARC Working Group to reach a conclusion about whether the way meat is cooked affects the risk of cancer.

Q. Is eating raw meat safer?
A. There were no data to address this question in relation to cancer risk. However, the separate question of risk of infection from consumption of raw meat needs to be kept in mind.

Q. Red meat was classified as Group 2A, probably carcinogenic to humans. What does this mean exactly?
A. In the case of red meat, the classification is based on limited evidence from epidemiological studies showing positive associations between eating red meat and developing colorectal cancer as well as strong mechanistic evidence.
Limited evidence means that a positive association has been observed between exposure to the agent and cancer but that other explanations for the observations (technically termed chance, bias, or confounding) could not be ruled out.

Q. Processed meat was classified as Group 1, carcinogenic to humans. What does this mean?
A. This category is used when there is sufficient evidence of carcinogenicity in humans. In other words, there is convincing evidence that the agent causes cancer. The evaluation is usually based on epidemiological studies showing the development of cancer in exposed humans.
In the case of processed meat, this classification is based on sufficient evidence from epidemiological studies that eating processed meat causes colorectal cancer.

Q. Processed meat was classified as carcinogenic to humans (Group 1). Tobacco smoking and asbestos are also both classified as carcinogenic to humans (Group 1). Does it mean that consumption of processed meat is as carcinogenic as tobacco smoking and asbestos?
A. No, processed meat has been classified in the same category as causes of cancer such as tobacco smoking and asbestos (IARC Group 1, carcinogenic to humans), but this does NOT mean that they are all equally dangerous. The IARC classifications describe the strength of the scientific evidence about an agent being a cause of cancer, rather than assessing the level of risk.

Q. What types of cancers are linked or associated with eating red meat?
A. The strongest, but still limited, evidence for an association with eating red meat is for
colorectal cancer. There is also evidence of links with pancreatic cancer and prostate cancer.

Q. What types of cancers are linked or associated with eating processed meat?
A. The IARC Working Group concluded that eating processed meat causes colorectal cancer.
An association with stomach cancer was also seen, but the evidence is not conclusive.

Q. How many cancer cases every year can be attributed to consumption of processed meat and red meat?
A. According to the most recent estimates by the Global Burden of Disease Project, an independent academic research organization, about 34 000 cancer deaths per year worldwide are attributable to diets high in processed meat. 

Q. Could you quantify the risk of eating red meat and processed meat?
A. The consumption of processed meat was associated with small increases in the risk of cancer in the studies reviewed. In those studies, the risk generally increased with the amount of meat consumed. An analysis of data from 10 studies estimated that every 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by about 18%.

The cancer risk related to the consumption of red meat is more difficult to estimate because the evidence that red meat causes cancer is not as strong. However, if the association of red meat and colorectal cancer were proven to be causal, data from the same studies suggest that the risk of colorectal cancer could increase by 17% for every 100 gram portion of red meat eaten daily.

Q. Is the risk higher in children, in elderly people, in women, or in men? Are some people more at risk?
A. The available data did not allow conclusions about whether the risks differ in different groups of people.

Q. What about people who have had colon cancer? Should they stop eating red meat?
A. The available data did not allow conclusions about risks to people who have already had
cancer.

Q. Should I stop eating meat?
A. Eating meat has known health benefits. Many national health recommendations advise people to limit intake of processed meat and red meat, which are linked to increased risks of death from heart disease, diabetes, and other illnesses.

Q. How much meat is it safe to eat? A. The risk increases with the amount of meat consumed, but the data available for evaluation
did not permit a conclusion about whether a safe level exists.

Q. What makes red meat and processed meat increase the risk of cancer?
A. Meat consists of multiple components, such as haem iron. Meat can also contain chemicals that form during meat processing or cooking. For instance, carcinogenic chemicals that form during meat processing include N-nitroso compounds and polycyclic aromatic hydrocarbons. Cooking of red meat or processed meat also produces heterocyclic aromatic amines as well as other chemicals including polycyclic aromatic hydrocarbons, which are also found in other foods and in air pollution. Some of these chemicals are known or suspected carcinogens, but despite this knowledge it is not yet fully understood how cancer risk is increased by red meat or processed meat.

Q. Can you compare the risk of eating red meat with the risk of eating processed meat?
A. Similar risks have been estimated for a typical portion, which is smaller on average for processed meat than for red meat. However, consumption of red meat has not been established as a cause of cancer.

Q. What is WHO’s health recommendation to prevent cancer risk associated with eating red meat and processed meat?
A. IARC is a research organization that evaluates the evidence available on the causes of cancer but does not make health recommendations as such. National governments and WHO are responsible for developing nutritional guidelines. This evaluation by IARC reinforces a 2002 recommendation from WHO that people who eat meat should moderate the consumption of processed meat to reduce the risk of colorectal cancer. Some other dietary guidelines also recommend limiting consumption of red meat or processed meat, but these are focused mainly on reducing the intake of fat and sodium, which are risk factors for cardiovascular disease and obesity. Individuals who are concerned about cancer could consider reducing their consumption of red meat or processed meat until updated guidelines related specifically to cancer have been developed.

Q. Should we eat only poultry and fish?
A. The cancer risks associated with consumption of poultry and fish were not evaluated. 





The International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, has evaluated the carcinogenicity of the consumption of red meat and processed meat.  

Red meat 

After thoroughly reviewing the accumulated scientific literature, a Working Group of 22 experts from 10 countries convened by the IARC Monographs Programme classified the consumption of red meat as probably carcinogenic to humans (Group 2A), based on limited evidence that the consumption of red meat causes cancer in humans and strong mechanistic evidence supporting a carcinogenic effect. 

This association was observed mainly for colorectal cancer, but associations were also seen for pancreatic cancer and prostate cancer. 

Processed meat 

Processed meat was classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer. 

Meat consumption and its effects 

The consumption of meat varies greatly between countries, with from a few percent up to 100% of people eating red meat, depending on the country, and somewhat lower proportions eating processed meat. 
The experts concluded that each 50 gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%.


 Q. Should we be vegetarians?
A. Vegetarian diets and diets that include meat have different advantages and disadvantages for health. However, this evaluation did not directly compare health risks in vegetarians and people who eat meat. That type of comparison is difficult because these groups can be different in other ways besides their consumption of meat.

Q. Is there a type of red meat that is safer?
A. A few studies have investigated the cancer risks associated with different types of red meat, such as beef and pork, and with different kinds of processed meats, like ham and hot dogs. However, there is not enough information to say whether higher or lower cancer risks are related to eating any particular type of red meat or processed meat.

Q. Could the preservation method influence the risk (e.g. salting, deep-freezing, or irradiation)?
A. Different preservation methods could result in the formation of carcinogens (e.g. N-nitroso compounds), but whether and how much this contributes to the cancer risk is unknown.

Active body, active mind: The secret to a younger brain may lie in exercising your body

It is widely recognised that our physical fitness is reflected in our mental fitness, especially as we get older. How does being physically fit affect our aging brains? Neuroimaging studies, in which the activity of different parts of the brain can be visualised, have provided some clues. Until now, however, no study has directly linked brain activation with both mental and physical performance.

As reported in the latest volume of the journal NeuroImage, an exciting new study led by Dr Hideaki Soya from the University of Tsukuba in Japan and his colleagues show, for the first time, the direct relationship between brain activity, brain function and physical fitness in a group of older Japanese men. They found that the fitter men performed better mentally than the less fit men, by using parts of their brains in the same way as in their youth.

As we age, we use different parts of our brain compared to our younger selves. For example, when young, we mainly use the left side of our prefrontal cortex (PFC) for mental tasks involving short term memory, understanding the meaning of words and the ability to recognize previously encountered events, objects, or people. When older, we tend to use the equivalent parts of our PFC on the right side of the brain for these tasks. The PFC is located in the very front of the brain, just behind the forehead. It has roles in executive function, memory, intelligence, language and vision.

With tasks involving the temporary storage and manipulation of memory, long term memories and inhibitory control, young adults favor the right side of the PFC, while older adults engage both the right and left PFC. In fact, with aging, we tend to use both sides of

the PFC during mental tasks, rather than just one. This phenomenon has been coined HAROLD (hemispheric asymmetry reduction in older adults) and reflects the reorganisation of the brain as compensation for reduced brain capacity and efficiency due to age-related structural and physiological decline.

In the NeuroImage study, 60 older men (aged 64-75 years) underwent an exercise test to measure their aerobic fitness. The men, whose physical fitness was found to vary widely, then performed a test to measure their selective attention, executive function and reaction time. This well-known 'color-word matching Stroop test' involved showing the men words meaning color, such as blue, green, red, but asking them to name the color of the letters rather than read the word itself. This is harder than it sounds. When the color of the letters does not match the word - blue, red, green - it takes the brain longer to react. This reaction time is used as a measurement of brain function. Activity in the PFC region of the mens' brains was measured throughout the test using a unique neuroimaging technique called functional near infrared spectroscopy or fNIRS. This technique provides a measure of blood oxygen concentration in surface blood vessels, indicative of activity in the brain's outer layers, using a set of wearable probes in a cap that is placed on the head. Active brain cells require fresh oxygenated blood which dislodges the deoxygenated blood from that region. fNIRS measures the changes in color between oxygenated red blood and blue deoxygenated blood and thus indirectly measures brain activity.

The results from these tests were combined and extensively statistically analysed to explore the associations between aerobic fitness, Stroop reaction time and brain activity during the Stroop test. As predicted for older adults, during the Stroop test both sides of the PFC are active, with no difference between right and left, verifying the HAROLD phenomenon amongst this group of men. Previous studies have shown that young adults favour the left side of the PFC for this task.

Analysis of the relationship between brain activity and Stroop reaction time revealed that those men that favored the left side of the PFC while performing the Stroop test had faster reaction times. This indicates that older adults who use the more youth-like, task-related side of the brain perform better in this test.

Next, the association between aerobic fitness and Stroop reaction time was analysed. Fitter men had shorter reaction times.

Based on these findings, the researchers correctly predicted that higher aerobic fitness would be associated with higher left-PFC activity. In other words, fitter men tend to use the more youth-like side of their brains, at least while performing the Stroop test.

Previous studies have not examined the interaction between the three factors under investigation in this study - aerobic fitness, mental performance and brain activation. Using clever statistical tests called mediation analyses to look at these interactions, the researchers found that aerobically fitter older men can perform better mentally than less fit older men by using the more important brain regions when needed. In fact, the fitter older men are using parts of their brains in the same way as when they were younger.

How do they do this? Professor Soya says "one possible explanation suggested by the research is that the volume and integrity of the white matter in the part of brain that links the two sides declines with age. There is some evidence to support the theory that fitter adults are able to better maintain this white matter than less fit adults, but further study is needed to confirm this theory."

If you are an aging woman, you will be wondering if these results can be applied to your female brain. Both aging sexes might also wonder whether increasing aerobic fitness later in life can increase mental fitness. The results aren't in, but I'm heading off for a brisk walk just in case.

Alcohol intake increases the risk of breast cancer

Saying that the link between alcohol and cancer is dangerous is nothing new.. Five Spanish universities and more than 300,000 female volunteers participated in a European investigation that is now confirming that alcohol intake increases the chances of developing breast cancer. This risk quadruples with the intake of each daily glass of wine or beer.

Thanks to the altruistic collaboration of 334,850 women between the ages of 35 and 70 from ten European countries, an international team of researchers has once again corroborated the link between alcohol consumption and an increased risk of suffering from breast cancer.

Five Spanish universities (Asturias, Granada, Murcia, Navarra and San Sebastián) participated in this investigation which forms part of the EPIC Study (European Prospective Investigation into Cancer and Nutrition), financed by the European Union and coordinated by the International Agency for Research on Cancer.

The results of the study confirm previous evidence concerning the relationship between alcohol intake and breast cancer. Of all of the females examined, 11,576 were diagnosed with breast cancer over the course of the eleven-year monitoring study.

María Dolores Chirlaque, one of the Spanish scientists who forms part of the EPIC team, explains that ''a woman's average risk of being diagnosed with breast cancer increases by 4% with each additional 10 grams/day of alcohol. In other words, a daily intake of one glass of wine or beer -- or less -- would correspond to a risk value of 1. However, if we increase our intake to two daily glasses of wine or beer, our risk would rise by 4%''.

Percentages rise as intake increases. ''Using a reference value between 0 and 5 grams per day, an increase of up to 15 grams/day is linked to a 5.9% greater risk of breast cancer,'' adds the professor from the University of Murcia.

The time when intake occurs is also important

The number of years of exposure to alcohol intake also influences a woman's risk of developing breast cancer. Thus, the longer a woman has been exposed to alcohol consumption, the greater a risk she has, especially if alcohol intake began before her first pregnancy.

''Alcohol intake is a breast cancer risk factor that can be changed by a personal decision to form healthy habits. Hence, women must be advised and forewarned of the possibility they have to control this factor,'' states the researcher.

As the authors of this study have concluded, these effects were observed in both hormone-receptor-negative as well as hormone-receptor-positive tumours, ''so everything points to non-hormonal causes that need to be further investigated''.

Advice for reducing risk factors

The European Code Against Cancer has established 12 tips for individuals to reduce their cancer risk. One of these tips says that ''If you drink alcohol of any type, limit your intake. Not drinking alcohol is beneficial for cancer prevention''.

According to the text, ''there is strong evidence suggesting that individuals can reduce their cancer risk by adopting healthy eating and physical activity. In Europe, individuals who follow healthy lifestyles have an 18% lower risk of cancer than those whose lifestyles and body weights are not in line with recommendations''.

This decreased risk is associated with a healthy lifestyle that includes a normal body weight (a body mass index [BMI] between 18.5 and 24.9 kg/m2); moderate physical activity for at least 30 minutes a day; breastfeeding (for women); a diet including foods mainly of plant origin, and a limited consumption of alcoholic drinks.

Blood pressure medication can't undo all damage

Treating out-of-control blood pressure with antihypertensive medication can greatly reduce your risk for heart attack, stroke and heart failure, but the current approach to treatment can't undo all of the previous damage or restore cardiovascular disease risk to ideal levels, a new Northwestern Medicine study suggests.

The study, published in the Journal of the American Heart Association, sought to determine whether effective treatment of hypertension could lower the risk of cardiovascular disease to that seen in people who have always had ideal blood pressure levels.

"The best outcomes were seen in those who always had ideal levels of blood pressure and never required medications," said Donald Lloyd-Jones, MD, chair of the Department the Preventive Medicine at Northwestern University Feinberg School of Medicine and senior author of the study. "Those who were treated with medication and achieved ideal levels were still at roughly twice the risk of those with untreated ideal levels. And, of course, people with untreated or uncontrolled high blood pressure were at even greater risk."

He stressed that it remains very important to treat high blood pressure and that lowering blood pressure with antihypertensive medications has been found to lower the risk of cardiovascular disease significantly in middle-aged and older adults.

The new findings strongly suggest that there should be an even greater effort to maintain lower blood pressure levels in younger adults to avoid increases in blood pressure over time that may eventually require medication.

"A greater focus on healthy lifestyles, such as healthier eating patterns, with more fruits and vegetables and lower sodium intake and regular participation in physical activity are the best means for preventing blood pressure levels that might require medication," Dr. Lloyd-Jones said.

Northwestern Medicine scientists analyzed data from nearly nine thousand participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) studies.

They found that MESA participants on antihypertensive medication (all aged 50 years or older at baseline) with well-controlled hypertension (<120 a="" and="" blood="" br="" cardiovascular="" compared="" disease="" events="" had="" half="" hg="" in="" levels="" low="" mm="" next="" nine="" of="" participants="" pressure="" risk="" same="" still="" the="" treatment.="" twice="" who="" with="" without="" years="">
Results from the CARDIA participants indicate that middle-aged adults with blood pressure well-controlled by medication had longer exposure to higher blood pressure levels throughout young adulthood than those with ideal blood pressure without medication. As a result, they had significantly higher risk of end-organ damage, as measured by left ventricular mass, kidney function, and the presence of coronary artery calcification.

Health benefits of pear consumption

To explore the potential health benefits associated with pear consumption and related health outcomes, Joanne Slavin, Ph.D., R.D., professor of food science and nutrition at the University of Minnesota, St. Paul, assisted by food science graduate Holly Reiland, conducted a systematic review of studies from PubMed (database of the National Library of Medicine with citations and abstracts of biomedical literature) and Agricola (database of the National Agricultural Library with citations of agricultural literature) from 1970 to present.

Pears are an excellent source of fiber and a good source of vitamin C for only 100 calories per serving. One medium pear provides about 24 percent of daily fiber needs. They are sodium-free, cholesterol-free, fat-free and contain 190 mg of potassium. The USDA Dietary Guidelines for Americans and CNPP MyPlate advise people who eat more fruits as part of an overall healthy diet are likely to reduce their risk of some chronic diseases, although little is published on the health outcomes associated with individual fruits, including pears.

In the review conducted by Dr. Slavin and Reiland, pears were found to be a source of fructose, sorbitol and dietary fiber. "Americans fall short on dietary fiber," said Dr. Slavin. "The high content of dietary fiber in pears and their effects on gut health set pears apart from other fruit and deserves further study." Slavin found the body of evidence for a relationship between pear intake and health outcomes to be sparse and diverse and believes intervention studies with pears that show positive health outcomes, most likely improvements in gut health, are needed.

According to Slavin, an epidemiologic cohort study conducted by Larsson et al.2 found, among individual fruit and vegetable subgroups, inverse associations with total stroke and the consumption of pears, along with apples and leafy green vegetables. In a meta-analysis of twenty prospective cohort studies Hu et al.3 found apples/pears, citrus fruits and leafy vegetables might contribute to stroke protection.

An epidemiologic study conducted by Wedick et al.4 linked the consumption of anthocyanin-rich foods, particularly pears, apples and blueberries, with lower risk of Type 2 diabetes. An additional epidemiologic study via Mink et al.5 indicated flavonoid-rich foods including pears were associated with a significant reduction in mortality from coronary heart disease and cardiovascular disease in postmenopausal women.

Inherent mindfulness linked to lower obesity risk, belly fat

A study of nearly 400 people finds that those who exhibited more 'dispositional mindfulness', or awareness of and attention to their current feelings and thoughts, were less likely to be obese and had less abdominal fat than people who did not exhibit as much of that awareness.

Dispositional mindfulness is not the same as mindfulness meditation, in which people make a conscious, focused practice of attending to their current state and sensations. Instead, it's more of an inherent personality trait, though it can also be taught.

"This is everyday mindfulness," said lead author Eric Loucks, assistant professor of epidemiology in the Brown University School of Public Health. "The vast majority of these people are not meditating."

Loucks' study, published in the International Journal of Behavioral Medicine, looked at how 394 people in the New England Family Study (NEFS) scored on the six-point Mindfulness Attention Awareness Scale (MAAS). Participants rated their agreement with 15 prompts, such as 'I find it difficult to stay focused on what's happening in the present' and 'I could be experiencing some emotion and not be conscious of it until some time later.'

The researchers also measured the amount of belly and hip fat each person had using the dual energy X-ray absorptiometry scanner at Memorial Hospital in Pawtucket. They also gathered measurements of body mass index and other data on each participant's health, lifestyle, and demographics.

The research team's analysis found that even after adjusting for a multitude of possible confounding factors (e.g., age, smoking, socioeconomic status), people with MAAS scores below four were 34 percent more likely to be obese than people with a score of six. Meanwhile, people with the lower MAAS scores had, on average, a bit more than a pound of belly fat (448 grams) than people with the high score. Both of these results were statistically significant.

Because the volunteers have been NEFS participants since childhood, the researchers could track whether they were obese as children. Among the study's findings is that people who were not obese as children but have become so as adults were significantly more likely to be low MAAS scorers.

Is the connection causal?

The study only measures an association, Loucks and his co-authors note. It does not prove that higher mindfulness causes weight loss. But here's what Loucks hypothesizes is going on: Like other animals, people are evolutionarily predisposed to stock up on calories when they are available and to rest when they get the chance. In prehistoric times that was a sensible survival instinct but in a first-world context of fast food and television, it can easily lead to excessive weight gain.

Mindfulness, which other studies have shown can help people overcome cravings and eat a healthier diet, Loucks said, may be the cognitive tool people need to overcome their instincts. Similarly, it may help people override an aversion to initiating exercise (research suggests that people feel great after working out but often feel ambivalent about getting started).

"That's where the mindfulness may come in," Loucks said. "Being aware of each and every moment and how that's related to what we do and how we feel."

Testing interventions

Loucks acknowledged that the differences inherent dispositional mindfulness seems to make, while significant, are not huge.

"Awareness seems to be enough to have a small to medium effect," Loucks said. "Then there is the question of what could we do to increase it."

Clinical trials of whether specific interventions enhance the apparent benefits of mindfulness would help determine whether it indeed has a causal role in lowering obesity risk. Prior studies of mindfulness in weight loss have yielded promising but still inconclusive results, Loucks said.